Basic Flashcards
Mention risk factors for DVT
Prolonged immobilisation
Pelvic or lower limb orthopedic surgery
Obesity
Family history of thrombosis
Dehydration
Mention 4 Operative RFs for wound dehiscence
Vertical incision
Muscle cutting
Non absorbable sutures
Closure under tention
Drain inserted at the site of wound
Enumerate 4 causes of non infectious post operative fever
DVT
Lung atelectasis
Wound hematoma
Surgical trauma
transfusion reaction
Pyrogenic reaction to drugs
Causes of postoperative fever that require immediate intervention
Bowl leakage
PE
Surgical infections that causes myonecrosis
Malignant hyperthermia
Acute adrenal insufficiency
Causes of postoperative dyspnea
Lung atelectasis
PE
Myocardial infarction,HF
Pneumonia
Huge ventral hernia repair
EXACERBATION OF asthma and COPD
4 ttt option for necrotizing facilities
Aggressive surgical debridement
Systemic antibiotics
Iv fluids,good nutrition
Control blood glucose in DM
causes and RFs for nosocomial infections
Decrease host defence by surgical assault
Decrease general resistance dt malnutrition or malignancy
Prolonged hospital stay
Disruption of normal physiological barriers
4 predisposing factors for ssi
Wound hematoma
Foreign body
Chronic disease
Dm malnutrition obesity
Improper sterilisation of surgical equipments
Ttt of gas gangrene
Massive debridement
Iv fluids and systemic antibiotics benzylpenicillin
Hyperbaric oxygen
Principles of ttt of hand infection
Hand should be elevated to reduce pain and edema
Hot fomentation
Empirical abs till results of C&S
Any pus should be drained
3 criteria of hand abcess drainage
Skin incision should be parallel to skin crease never cross it
Incision should be made in a point of maximum tenderness
Midline incision is # in digit instead mid lateral incision
Mention causes of non healing fistula
🍑Epithelisation
🍑FB or necrotic tissue.
🍑Ischemia🍑 irradiated tissue
🍑Hypoproteinemia or malnutrition
Mention 4 causes of SIRS
Major trauma
Major operation
Major inflammation
Major burn
Class 4 , amount of blood loss ……
> 40% >2000ml
Mention 3 compensatory mechanisms during acute hge
Increase catecholamines which causes vc of BVs and tachycardia, increase cop
Increase stress hormones
Increase insulin resistance
Increase ADH
Increase respiratory rate
Mention 5 complications of blood transfusion
Febrile non hemolytic transfusion reaction
Hemolytic reaction non compatible blood transfusion
Allergic reaction
Transmission of infections HIV, HBV , HCV syphilis
Transfusion related acute lung injury TRALI
Enumerate 4 complications of massive blood transfusion
Circulatory overload
Hyperkalemia
Metabolic acidosis
Coagulopathy & DIC
Causes of hypokalemia
🌻Severe diarrhea
🌻K losing diuretics
🌻Metabolic alkalosis
🌻Conns syndrome
Mention 4 causes of metabolic acidosis
DKA
Lactic acidosis
Chronic renal failure
Salicylate toxicity
Mention 4 causes of metabolic acidosis
DKA
Lactic acidosis
Chronic renal failure
Salicylate toxicity
Complications of parenteral nutrition
Hyperglycaemia
Hypercholesterolemia
Hyperchloremic metabolic acidosis
Catheter associated sepsis
Complications during insertion of central Iv line
Pneumothorax
Air embolism
Cardiac tamponade or perforation
Injury to adjacent artery
Mention 6 types of acquired cysts 🌞
🌹Parasitic cyst , hydatid
🌹Implantation dermoid cyst
🌹Retention,Sebaceous cyst
🌹Neoplastic cysis
🌹Traumatic cyst
🌹Exeudation cyst bursa
Postoperative Local wound complications
Seroma
Hematoma
Infection SSI
dehiscence or evisceration
Incisional hernia
Causes of postoperative fever
Response to surgical trauma
Atelectasis
SSI
RTI , UTI
Anastomotic leak
DVT
Mention types of nutritional support é examples
🪷Enteral feeding
1.Sip feeding
2.NGT Rhyl tube
3.Feeding gastrostomy
4.Feeding jejunostomy
🪷Parenteral feeding
1/Central IJV SCV
2/Peripheral
3/ PICC , Peripherally inserted central venous catheter
Mention complications of wound healing
🌿Early
Hematoma
Seroma
SSI
EVISCERATION DEHISCENCE
🌿late
Hypertrophic scar
Keloid
Ugly chronic scar
Contracture
Marjolin ulcer
Stitch sinus
Stitch marks
Mention 5 methods of prevention of wound infection
🌹The patient
Improving general condition
DM control
ttt of malnutrition
Anemia correction
Ttt of any septic focus
Skin antiseptics
Hair trimming just preoperative
🌹The surgery
Good hemostasis
Avoid hematoma and seroma
Avoid dead space
Appropriate abs
Remove any necrotic tissue or FBs
Shorten post op stay
Delayed primary closure of contaminated wound
🌹==>Proper strelization of surgical instruments
Antibiotics
High concentration in required tissue
No liver or kidney toxicity
Suitable for organism
Discuss 5 complications of massive blood transfusion:
A. Hyperkalemia, if blood is old and hemolysis occurs releasing intracellular potassium, may cause cardiac arrhythmia and arrest.
B. Hypocalcemia, due to excess citrate, which is
used as anticoagulant, it binds to the calcium
C. Circulatory overload (heart failure), due to expansion of the intravascular volume.
D. Hypothermia, as the blood is stored at 4 degrees, it may cause coagulopathy and acidosis.
E. Coagulopathy and DIC, as stored blood is deficient
on platelets and coagulation factors
F. Metabolic acidosis, due to the hyperkalemia and hypothermia
Enumerate Factors affecting wound healing ?
1) location and vascularity
2) immobilization and shearing forces
3) infection
4) surgical technique
5) presence of fbs or necrotic tissue
Types of acute wounds é examples
Open wounds
Stab , puncture , cut , incised , abrasion friction burn
Laceration degloving traction avulsion
Closed wounds
Compartment S
Crush S
Contusion , bruises
and hematoma
What factors increase the risk of postoperative respiratory complications
Smoking
Old age
Obese
Hypoproteinemia
Uper bdominal or thoeacic surger
HF
Chronic steroid use
Recommendation for pulmonary t
Risk reduction
preoperative
Stop smoking for at leaset 8 wka b4 surgery
Ab prophylaxis and delay surgery if there is chest infection
Education of the patient to do respiratory exercise after surgery
Ttt of any rt obstruction in COPD and asthma
Intraoperative
Limit the time of surgery to less than 3 hrs
Avoid use of pancournium
Use laparoscopic procedure when possible
Use spinal or epidural anesthesia
Postoperative
The patient should do extensive respiratory exercise
CPAP
Use epidural analgesia
Intercosral nerve block
Postoperative
Obesity has increase risk of
Delayed wound healing
Infection
Regurgitation, difficult intubation
Bed sore
MI DVT
cerebrovascular accident respiratory compromise
Mechanical problems
Child mortality risk classification (hepatic pati)
Child A 10%
Child B 31%
Child C 76
When to postpone elective surgery
★Tight MS or AS untill surgically corrected
★SBP>160
DBP>95
★MI in past 6mns
★HF until controlled
★PTA Within 6 wks
★Chronic smoking until patient stops at least 8 wks
General post operative complications
Post operative fever
Complications of thermal regulation
DVT
cardiovascular
Circulatory collapse
Neurological
Renal
Suprarenal
Thyroid
Pulmonary
Mention post operative git complications
Paralytic illius,acute gastric dilatation
Gi bleeding
Post operative nausea and vomiting
Causes of postoperative gi bleeding
Curling ulcer dt stress
Gastritis dt postoperative NSAIDs as analgesia
Mallory wise s dt excessive vomiting
technical errors in anastomotic surgery or stapling
RFS OF postoperative nausea and vomiting
Female sex
Operation in a young adults
Preoperative vomiting
Motion sickness and migraine
NSAID Postoperative
Poor pain control
Acute gastric dilatation
Paralytic illius
Causes of post operative collapse and rapid general deterioration
CVS
PE
MI
heart failure
Stroke
Arrhythmia
RESPIRATORY
Failure to reverse anesthesia
Respiratory depression by drugs
Respiratory infection
METABOLIC
Acute adrenal insufficiency
Hypo or huperglycemia
Electrolytes distubance
INFECTION
Sepsis
Septic shock
Ssi
SURGICAL
Slipped ligature
Acute blood loss without compensation
Decompensated dehydration
DRUG REACTION AND ANAPHYLAXIS
Causes of postoperative fever
In first 2 days
Effect of surgical trauma
Atelectasis
From 3 to 5
Superficial and deep SSI
5th day
UTI Especially è catheter
RTI especially in patients with COPD
Central line infection
The 7th day
Anastomotic leak
Intracavitary collection
Abcesses
Causes of postoperative low blood pressure
Morphine
Epidural or spinal anaesthesia
MI
Dehydration
Blood loss
Components of metabolic response to trauma
Neural response
Endocrinal response
Microcirculatory changes
Cellular damage and acute inflammatory response
SIRS early reversible , late irreversible
Criteria for SIRS diagnosis
Temperature ≥38 or ≤36
Tachycardia>90
Tachypnea>20
Pco2 ≤32 mmhg
Need of mechanical ventilation
Leukocytes ≥12000 or ≤4000
Or band cells >10%
Factors that worse SIRS
hypovolemia
Hypothermia
Malnutrition
Psychological stress
Pain
Explain the pathology of SIRS
Initiated by circulation of
🌿Inflammatory cells pnl mq
🌿Cytokines IL 1 ,6, 8, TNF a
🌿Pro inflammatory mediators ( proteases o free radicals, prostaglandins,kinins )
🌿Anti inflammatory mediators (IL 10 ,protease enzymes inhibitors, antioxidants)
🌿Complement
🌿Bacteria and toxins
These mediators cause endothelial dysfunction and widening of capillary pores ,escape OF plasma proteins to interstitial space dragging water after them leading to hypovolemia and systemic hypoperfusion and may cause MOF
Define MOF and sequence of individual organ damage
Is failure of 2 or more than organs making it difficult to. maintain homeostasis without external support
Sequence
1.Lung
2.Liver
3.Intestine
4.Renal
5.Heart
Explain the mechanism of pulmonary failure in MOF
As a part of systemic endothelial dysfunction
Pulmonary endothelial cells leak and the alveoli become filled of water this impair ventilation
Opening of pulmonary arteriovenous shunts this cause capillaries hypoperfusion ==>impair perfusion
Interstitial edema ==> impair diffusion
📌MRSA is sensitive to
📌VISA is sensitive to
📌Vancomycin
Teicoplanin
📌Linezolid
Daptomycin
Tigecycline
Infections caused by streptococcus pneumoniae
Otitis media
Meningitis
Post splenectomy infection
COPD exacerbation
Bronchopneumonia in susceptible patients
Anaerobic streptococcus cause
Part of mixed flora present in Intraperitoneal abcess
Areas with necrotic tissue as diabetic leg ulcer
Ttt if strept
Penicillin is DOC
It is also sensitive to macrolides like erythromycin and claritheromycin
Meningitis
Ceftriaxone and vancomycin
The drug that cannot be used in enterococci is
VRE is treated by
Cephalosporins
Daptomycin and Linezolid
Enterobacteriacea r treated by
2&3rd generation cephalosporins,gentamycin and fluroqunolines cipro,levo,moxifloxacin
Cephalosporins resistance ==>carbapenem and amikacin
Carbapenem resistance ==> colistin
Psedomonas presents in
It is….. ,% normal commensal
Affects debilitated patient
Compound fractures burn catheter
10
Psedomonas ttt by
Orally effective ttt ciprofloxacin and ofloxacin
Ceftazidim, cefepim carbapenem (piperacillin tazobactam)
Causes of necrotizing fasciitis
📌After drainage of perianal abcess or ischiorectal abcess
📌After IM or IV injection
Ttt of necrotizing fasciitis
Prevention
Adequate wound debridement
Ab prophylaxis
Blood transfusion to avoid Ischemia
Curative
Aggressive debridement
Systemic ABs penicillin iv 20-40million u per day+gentamycin
DM control
Fluid nutrition blood transfusion
Causative organisms of necrotizing fasciitis
Streptococcus
Ecoli
Anaerobic flesh eating bacteria
Associated with fournier gangrene of scrotum
Maleny’s synersism
Intestinal barrier is broken by
Decrease luminal nutrition of entercytes
Mesenteric ischemia
Altered intestinal flora
This lead to ==>bacterial translocation ==>portal circulation
If Kupffer cells of the liver r impaired
Systemic sepsis==>MOF
Predisposing factors of Ssi
🌻Patient factors
Debilitating disease
Immunosuppression (chemotherapy, chronic steroid use , DM)
Obesity
Chronic disease
Unfavorable local tissue condition
Presence of septic focus
🌻 Exogenous factors
Type of surgery
Breech of infection control
Improper sterilisation of s equipments
Presence of hematoma or seroma
Presence of dead spce
🌻 surgical factors
Presence of Fbs
Improper surgical technique
Local tissue ischemia and edema
Indications of Abs in crean operation
Implant (mesh and graft)
Infection will be very severe or life threatening
Patient with valvular heart lesion (IEc)
Emergency surgery
Ssi appears bt day ….,….
Earliest manifestion
5-10
Wound pain and postoperative fever
Ttt of Ludwig’s angina
Early massive doses of Abs amoxicillin and metronidazole
Semi setting position
Late submental curved incision of skin and deep fascia
Ingrown toenail ttt
For mild cases
*The overhanging nail fold is pushed away and reduced in size by daily packing of the lateral groove with antiseptic gauze
*Antibiotic ointment
*Avoid wearing tight shoes
*Warm water salt soaks
Operative
Excision of a wedge including granulation and nail bed
In extensive cases removal of the whole nail with it s bed
Pfs of gas gangrene
The condition is very common in battle wounds
Muscle wound contaminated by soil feces
High volecity gun shot causing bowel perforation
Associated with amputation contaminated with stool
Ttt
Plus hyperbaric oxygen for several hours daily
Anti gasgangrene toxin infusion is given
The role of neurotoxin of colistridium tetanii
Anticholine esterase action interfere è destruction of ach causing generalized tonic regidity of muscles
Convulsion attacks on exposure to minor stimuli
Dd of tonic clonic contraction of tetanus
Tonic tetanus trismus meningitis
Clonic hydrophibia of rabies strychnine poisoning
Tonic tetanus trismus meningitis
Clonic hydrophibia of rabies strychnine poisoning
Complications of streat wound
Local
Infection
Tissue indury FT
SCAR كل الانواع
General
Hge hypovolemic shock
ARF
Compartmental s
Factors affecting wound healing
Local
Ischemia
Immobilization
Irridiation
Infection
Tension
Wound closure method
systemic
Age
Malnutrition
Drugs
Debilitating disease
Chronic diseases
A
Ttt of keloid and hypertrophic scar
Pressure application
Intralesional steroid
In keloid post operative radiation
Combination of surgery and RT the best
